Provider Demographics
NPI:1790738557
Name:WILCOX, CATHERINE GRACE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:GRACE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 S SHORE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-5466
Mailing Address - Country:US
Mailing Address - Phone:269-963-7851
Mailing Address - Fax:
Practice Address - Street 1:395 S SHORE DR STE 102
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-5466
Practice Address - Country:US
Practice Address - Phone:269-963-7861
Practice Address - Fax:269-963-0579
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010172101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3367672Medicaid